Articles, PSQH March 13, 2018

EMRs: Are We There Yet?

by Barry P Chaiken, MD

While rock’n’roll came of age and hippies invaded San Francisco, a small hospital in Mountain View, CA, in the heart of what was to become Silicon Valley, teamed up with the Lockheed Corporation and began the development of the first computerized patient record. El Camino hospital, formed by a group of concerned citizens and physicians and funded by a special tax levy in the late 1950s, worked for 2 years with Lockheed and deployed the first electronic storage of patient information in 1973. With Apple, Intel, and Microsoft not the computer giants they are today, computer hardware, software and training costs proved very expensive preventing many other hospitals from following in El Camino’s footsteps.

As other industries adopted computers and transformed their processes, hospitals in the 1980s rarely employed computers in clinical care. Most digitization occurred in back-office systems such as finance, human resources, and supply chain. As the era of the personal computer took hold in the 1990s, EMRs began to pop up in ambulatory settings where the application complexity and deployment difficulty were ameliorated by the increasing processing power and decreasing cost of rapidly evolving computer systems.

Although former President George W. Bush pushed for the digitization of medical records during his first term, real momentum did not build until the financial crisis hit, and the federal government 2009 fiscal stimulus package earmarked billions of dollars to hospitals and physicians to adopt EMRs. Despite the evolution and investment in EMRs over the past five decades, little evidence exists that all this digitization is making a difference in quality, safety, or cost.

Excerpts from EMRs: Are We There Yet? PSQH, Winter/Spring 2018

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